Document 0050
 DOCN  M9650050
 TI    [Problems in the diagnosis and therapy of lymph node tuberculosis in
       HIV-negative patients]
 DT    9605
 AU    Canova CR; Kuhn M; Reinhart WH; Medizinische Klinik, Kantonsspital Chur.
 SO    Schweiz Med Wochenschr. 1995 Dec 26;125(51-52):2511-7. Unique Identifier
       : AIDSLINE MED/96143633
 AB    Tuberculosis is the world's foremost cause of death from a single
       infectious agent in adults. During the past decade the nature and
       magnitude of the problem of tuberculosis have dramatically changed. Much
       of what physicians have learned about this disease is no longer true and
       tuberculosis has become a new entity. Migration from developing areas
       with a high prevalence of tuberculosis to industrialized countries, and
       the problem of HIV infection, have introduced new components to the
       epidemiology. We report three cases of young immigrants with lymph node
       tuberculosis. One patient was successfully treated with the usual
       9-month-regimen. The other 2 patients, however, developed new lymph
       nodes or enlargement of existing nodes during treatment. They underwent
       further examinations, including surgical biopsies, because of diagnostic
       uncertainty (tuberculosis, superinfection or lymphoma). Finally the 2
       patients were successfully treated with antituberculous agents for 12
       and 15 months. These cases prompted a review of the literature and a
       reevaluation of the management of lymph node tuberculosis, including the
       value of surgical biopsy in the diagnosis of tuberculous lymphadenitis.
       We conclude that selective surgical biopsies should be recommended for
       differential diagnosis of tuberculous lymphadenitis. Histological
       examination (caseating epitheloid cell granulomas and giant cell
       formation) and microbiological examination (Ziehl-Neelsen staining and
       culture of native material) should be performed. Newer methods, such as
       amplification and detection of mycobacterial DNA, are rapid and
       sensitive tests helpful for diagnosis. Lymph nodes may increase in size
       and new nodes may appear both during and after chemotherapy, without
       indicating a failure of treatment or relapse. The usual treatment is a
       9-month-regimen with rifamipicin, isoniazid, pyrazinamid and ethambutol.
       Prolonged or modified regimens are, however, necessary in some
       individuals.
 DE    Adult  Antitubercular Agents/ADMINISTRATION & DOSAGE/THERAPEUTIC USE
       Case Report  Diagnosis, Laboratory  Drug Therapy, Combination
       Emigration and Immigration  English Abstract  Female  Human  *HIV
       Seronegativity  Male  Tomography, X-Ray Computed  Tuberculosis, Lymph
       Node/*DIAGNOSIS/DRUG THERAPY  JOURNAL ARTICLE  REVIEW  REVIEW, TUTORIAL

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